Strategies to Improve CPAP Adherence: Zhenjiang Experience

Abstract

Objective: High dropout rate of CPAP is a big challenge. To improve the CPAP adherence, systemic upper airway management including subjective and objective nasal patency assessment, surgical and medical treatment to upper airway obstruction, and CPAP follow-up strategies were carried on in the present study. Method: A prospective study. A total of 169 OSA patients (women: 34; mean age, 42.9 years) and 41 healthy subjects (women: 9; mean age, 38 years) were undertaken for polysomnography and subjective and objective nasal patency assessment. CPAP users with upper airway disorder were treated with medication or surgically and followed for up to 3 years. Results: Average bilateral nasal cavity volume (2-5 cm from nostril) was 4.97 mL in OSA subjects and 6.43 in healthy subjects ( P < .01), and average nasal respiratory resistance was 2.03 Pa·cm-3·s-1 in OSA subjects and 0.44 in healthy subjects ( P < .01). There was no significant nasal patency difference among mild, moderate, and severe OSA patients. In 59 CPAP users, 27 were treated with nasal steroid spray and/or decongestant, whereas 10 were treated surgically (8 septoplasty and 2 tonsillectomy + UPPP). A total of 38 patients (64%) kept using CPAP over 4 hours per day, 9 (15%) dropped out, and 12 (21%) were lost in the 3 years follow-up. Conclusion: The incidence of nasal patency disorder was higher in OSA patients. Nasal airway assessment was helpful to foresee and deal with the problems with CPAP treatment, which would encourage patients to adhere to the treatment with medical or surgical interferences.